A Pakistani in an Afghan Hospital

Outside the snow had been falling thick and fast for the past three days, inside we were closeted in an overheated apartment with diminishing oxygen.

Around midnight I felt myself drifting into Fairy Meadows – a condition first experienced during a high altitude trek around the Fairy Meadows. I tossed about a bit, tried sitting up, took long breaths but nothing worked, I only managed to wake Nafisa up. Now I had to reassure her that it was nothing serious while struggling for breath. Then cold sweat and lightness in the head started to set in, I tried to get up but collapsed gasping on to the floor. My mind was switching on and off but I could sense panic breaking around me. Nafisa had got Aimal and his doctor wife from the flat below, the doctor fearing cardiac arrest wanted me removed to a hospital immediately. I weakly resisted, knowing that this would inconvenience everyone, but I was piggy-backed three floors down and put in a Taxi. We made for the nearby Shiroonzada plaza – a medical complex of sorts where private practitioners run one room clinics. The complex was closed; someone managed to get a drowsy doctor who reprimanded us for wasting time and advised that we go to the Wazir Akbar Khan Hospital. I passed out again. Only to be awakened by palm size snow flakes hitting my face and drenching my neck, I was being carried on a stretcher into the hospital. This place wasn’t much help either; they couldn’t handle serious emergencies and had no room anyway. The staff tried to help though. A nurse brought in an old ECG machine, cranked out a report and somberly pronounced that as my time was up, I should be taken home and all should pray. Then lovingly, as a parting gift he attached a cannula to my wrist – I couldn’t help wondering how this was going to help me in the hereafter. Our next port of call was Shifa Khana Jamhooriat, again a facility geared to treating war wounded and not heart patients.

By now Nafisa had overcome her initial panic and had started to take matters in her hand. She managed to contact the head of the Char Sad Bistar (Four Hundred Bed) Hospital and on his assurance we started for Kabul’s prestigious military hospital. By now some friends and family had joined us and we were moving in a small convoy of cars led by an ambulance. At the hospital they were waiting and I was rushed to the hospital emergency. They started taking ECGs at regular intervals and constantly monitored my blood pressure – my systolic seemed to be in a free fall. I was put on Oxygen and shifted to a quieter corner of the emergency. The place was rather busy, people with broken limbs were being brought in all the time, caused by slipping on the hardening ice outside, I presume.

The morning started with everyone wanting to check my Istalam (right to admittance) as this was a military hospital. All treatment was on hold till the Istalam issue got settled. Finally the head arrived and scribbled a note saying that I should be admitted as I was his sister’s husband – he was tweaking facts a bit here but then doesn’t the Book itself declare us all siblings. I was formally admitted and shifted to a small six bed ward on the seventh floor. I was the only patient in the room, and the large bay windows provided a magnificent view of a snow white Kabul. I couldn’t fail to notice that the Char Sad Bistar was a sprawling medical complex with hospital blocks, pharmacies, laboratories, a medical college and hostels. Later I was to discover that the main building had nine floors and its basement was connected by a wide underground passage to kitchens located across the main road. On the rooftop was a helipad served by hospital’s bed-capacity lifts. Built by the Soviets, this hospital delivered its best during the long civil war of the 1980s. It was claimed that during this war, casualties from across the country were on the hospital’s operating table within the hour. It must have been a leading military hospital in the region then.

In modern times most Afghan wars have been foreign ventures. In the late 19th Century, exasperated with British loosing face in the great game, Governor General Lytton declared that Afghanistan was but “an earthen pipkin between two metal pots” and dispatched an Army to deal with the problem. A hundred years later, Americans decided to make Afghanistan a cold war battleground and in the process turned the pastoral pastures of Afghanistan into killing fields. To win this war Americans exploited religion and flooded the country with sophisticated arms and greenbacks and in the process permanently destabilized the whole region. This American venture was fully backed by the Saudis, who did not want dominos falling in their neighbourhood. Pakistani Generals also joined the binge, trampling over national interest to please the Americans and amassing huge personal wealths. An insular Soviet Union bled for having bitten more than it could chew and its 40th Army returned across the Hairaton Bridge with General Boris Gromov leading from behind. In a conflict not of their making, it was the Afghans who suffered the most – as graphically described by a local adage that ‘it’s the frogs that get trampled when oxen chose to fight’.

Throughout the war the Char Sad Bistar hospital functioned way beyond its capacity. When the rooms got filled, patients were accommodated in unending rows lining the wide hospital corridors and they were attended to by a legendry team of dedicated doctors, such as General Suhaila and Khan Aqa Syed, to name but a couple from a long list. They performed operations around the clock and when too exhausted collapsed on the nearest available bed to catch a wink. General Suhaila has worked at the hospital through the Communist, Mujahideen and Taliban regimes to the present time. She served the nation through its darkest days without compromising her personal values – during the Taliban regime she was the only woman in Kabul who came to office in trousers with her head uncovered. This strength of character made her one of the most respected women in Afghanistan. And this speaks volumes for the real inner values of an outwardly conservative society.

In the afternoon they wheeled in the Dagarwal (Colonel) and put him on a bed next to mine. Dagarwal with his thousand and one tales is a veritable modern day Sheharzade or better call him an Afghan Flashman, as he seems to have participated in all major Afghan military campaigns of the past three decades. Once he even led his tank column into Iran to commandeer a bit of fuel. At first I was a bit puzzled by his omnipresence – he seemed to be out at the front and here in the hospital at the same time. The mystery started to dissolve once I discovered that not only the Dagarwal but most of his family were long term patients at the hospital with undiagnosed internal complaints. Occasionally, tired of routine hospital food the family gathered in our ward to have something different – mostly barbecued fish from the bazaar. Fish smell triggered my vomiting routine, but thankfully this went unnoticed as the Dagarwal was busy holding family court.

Once satisfied that I was not a special ISI agent sent to turn the whole Afghan officer corps against India, the Dagarwal took me under his wing. It turned out to be a huge learning experience. For one he provided me with some very original percepts on recent Afghan history and society, which are best left untold. I also learnt the Dagarwal speak with its rich and creative vocabulary. For example, he always referred to the Mujahideen as Mujahileen (the ignorant ones) and to Islami Jihad as dollari Ilhad (godlessness). Dagarwal’s condition worsened every morning and lasted till after the senior doctors’ round. He then got busy in his pet project, which was to get the army medical board to recommend him for treatment in Turkey. The board was about to meet and having been refused twice already, the Dagarwal was determined to succeed this time. He had established a small network for the purpose and every morning this group met for a strategy update session. Not to be in their way, I got Nafisa take me out in the corridor.

We park the wheelchair in the veranda and enjoy a wonderful view of Tapa Bibi Mahroo all shrouded in white. This tapa (hill) has historically provided an alternate citadel removed from the old city. On the top of the tapa one can see the remains of the Olympic size Russian swimming pool, down below is the British built Qala Jangi (War Fort). After a century and a half it is being rebuilt by the Americans, but history is not on their side either.

Around midday the meal ritual begins with an ear splitting din – the clanking of metallic trolleys, steel utensils, trays, cutlery and above it all the shrill shouts of the kitchen lady. Dagarwal announces that the taifa i ahangara (iron mongers brigade) is on the move and muffles his ears in preparation. Food is provided to all patients and their attendants, Dagarwal occasionally complains about the quantity but the quality is not bad: meat, vegetables, bread and rice and a piece of fruit. Sometimes you even get a choice of soups. My preference of dal soup over yakhni is a constant source of disappointment for the Dagarwal – no self respecting Afghan eats dal, not in public anyway. He lectures me on the nutritional and curative values of yakhni and disparages dal by repeating choice Afghan gozak jokes from the rich local repertoire. But I cannot help it, in my present state I just can’t keep the hospital yakhni down.

Nights are restless. For some unknown reason, all essential drugs are kept in our room. Throughout the night, the routine of switching on the lights, opening the creaking cupboards and quarrelling over missing medicine is repeated many times. Last night they managed to knock over one of the large oxygen cylinders, it sound like an IED going off and Nafisa woke up with a scream, the commotion lasted quite a while. On the first night they wouldn’t allow Nafisa to stay on as a night attendant in a male ward, but no one objects anymore. Her coup de grace was getting Khala Makai, an ex head of nursing and now a part of the Afghan Diaspora, to call some of her old colleagues. Nafisa has even managed to soften to some extent Dagarwal’s pronounced male chauvinism.

It seems that the main cause of my restlessness is low BP. Night provides a good opportunity to further test my theories on the subject, which I call “Brain function as determined by Blood Pressure”. My current state of research indicates the following: a) extremely low BP stops conscious brain function, b) very low BP results in brain repeating a single thought or sentence over and over, c) low BP means fretful half sleep with anguished dreams. This ‘research’ is a good pastime in my current situation – long winter nights, changing mental activity levels and availability of state of the art digital BP measuring devices.

Ours is a modest size ward but it contains more electronic medical equipment than most hospitals back home. Each bed is fitted with large monitors with half a dozen probes that can record and display all possible vital signs. The first couple of nights they attached these probes to my body and I could not move a muscle, just lay still and awake all night. As nobody bothered to look at the recordings, the third night I quietly removed the probes and nobody has put them back. I have also discovered that most electronic measuring devices are not very reliable. It may have something to do with the initial settings but no two BP measuring devices give the same result and the difference can be a good ten units or more. As a rough estimate I would say, our ward has some two hundred thousand dollars worth of goodies. Fancy digital equipment from little known USA manufactures – all gadgets boldly display that they are USA Government approved. The beds, furniture, electrical fittings, aluminum frames and glass are all pricy Pakistani makes. But what really shocked me were the hundreds of brand new imported stretchers, wheelchairs, beds and other hospital knick knacks dumped and rotting out of sight on the back stairway. It reminds me of all those Afghan hospitals were patients have to share a bed, a tattered piece of canvas with bamboos stuck at either end acts as the sole hospital stretcher and there are no wheelchairs. And a rage starts to swell within that I know not how to vent.

I often think about this at night. Simply put it is a case of easy come easy go, with plenty of corruption in between. Perhaps it is more noticeable in Afghanistan right now, but the disease is rampant in Pakistan and indeed across the world. How do you combat this corruption malaise and where do you begin. Prosperity, culture and a non-capitalist order can help but personal integrity in a postmodern world is not an easy get. All narratives of morality (values, if you will) stand discredited. Religion is dead and the ‘ism’ ideologies have failed to remove this darkness at the heart of modern human society.